The Clinical Challenge: Alcohol project seeks to improve outcomes of patients with at risk alcohol use or an alcohol use disorder by improving the alcohol assessment and intervention skills of medical students. To accomplish this goal we will build upon our platform independent Clinical Encounters 3D-Patient Training Environment. This project expands the Clinical Encounters 3D-Patient Training Environment by increasing realism and reframing the training as a challenging game to be mastered. Branched path learning, exposure to clinical consequences, and time-pressure heighten the challenge. Succeeding in the game and thus acquiring requisite alcohol assessment and intervention skills requires engaging in an experience, optimizing and refining skills, and choosing winning [best-practice-based, patient-centered] approaches. The game duplicates the real-world challenges of patient care, but efficiently provides a wide variety of clinical experiences. In the deliberate practice, they assess, intervene, and experience consequences that might be missed in our fragmented health care system. As an example, our simulated patients are not lost to follow up. This project uniquely adds the challenge of time- pressure. As in today's treatment environment, time is not unlimited; players must efficiently interact with patients and rapidly commit to the proper course of action. Students conduct interviews and perform standardized assessments with virtual (e.g., computer generated) patients. They receive differing simulated patient responses (e.g., acceptance, confusion, refusal, suspicious behavior) and preceptor feedback in response to the choices and decisions they make. To categorize alcohol use and, as indicated, establish an alcohol use diagnosis, they proceed to select physical exam components and select and interpret diagnostic screens and tests. As appropriate for health professional students in the early stage of their clinical training, students develop an evidence-based treatment plan that minimizes risk of at use drinking and provides appropriate follow-up. Game points and visual rewards reinforce best practice choices and enhance student engagement. Phase I demonstrated product feasibility and acceptability by completing: 1) needs analyses and preference testing with target audience students and faculty; 2) a training framework and game design document; 3) a semi-functional, interactive prototype of the planned training with realistic 3D characters; 4) assessments to be used in the Phase II evaluative study of the product; and 5) alpha/usability testing of the prototype with medical students. Phase II will complete the work, produce the Clinical Challenge: Alcohol Implementation Guide for faculty preceptors and training directors to implement the game, and evaluate its effectiveness with a population of medical students. A robust evaluation of the game will assess learner response to this novel approach in terms of acceptance, enthusiasm, and impact on skills, confidence and attitude via a randomized, cross-over, wait list control, pre-test/post-test design. It will compare change in target clinical skills and core competencies related to alcohol assessment and intervention. The robust assessment of Clinical Challenge: Alcohol informs our own environment and provides guidance to other researchers and educators regarding the ability of game-based 3D environment training to instill clinical skills an behaviors in students.